posted at 2:41 pm on January 28, 2014 by Allahpundit

Via the Free Beacon, a vivid illustration of how the Affordable Care Act keeps coverage “affordable.” All you need to do is exclude the pricier doctors and hospitals, like Cedars-Sinai in L.A. and Sloan Kettering in New York, from a plan’s provider network, and voila — savings.

The top lobby group for US health insurance plans, America’s Health Insurance Plans, said the new healthcare law brought “new costs” to the industry and that selecting hospitals and physicians that meet “quality standards” was one way of making health plans more affordable for consumers.

But Mr Priselac at Cedars-Sinai in Los Angeles says the creation of ever more narrow provider networks by insurers is being driven by price alone, and not by quality. He says the hospitals that are being excluded are leaders in innovation, which saves billions of dollars for the healthcare system in the long run.

The Oklahoma Republican’s spokesman confirmed to POLITICO that since the senator enrolled in his health insurance plan under Obamacare, his coverage has been reduced and he lost coverage for his cancer specialist. Coburn will continue to pay out of his own pocket and see the oncologist, his office said…

“We hope the White House will work with us to make sure Americans who can’t afford to pay out of pocket don’t lose access to life-saving care,” spokesman John Hart said. “As Dr. Coburn’s experience shows, the American people are about to learn they’re going to lose access to not only their doctors and plans, but their specialists and treatments.”

Have provider networks shrunk that much even among “gold” and “platinum” plans on the exchanges? That’s what Coburn, who’s already survived previous bouts with cancer, would have purchased, I assume. It’s no secret that “bronze” and “silver” plans help pay for their lower premiums by keeping provider networks comparatively small; I assumed one of the benefits for shelling out for a cadillac plan would be a robust network. Not robust enough, apparently.

If you missed it in Headlines yesterday, read Philip Klein’s critique of Coburn’s proposed alternative to ObamaCare. It’s not a wholly new paradigm so much as an overhaul of O-Care itself — higher premiums for the old to provide relief to the young, coverage for preexisting conditions only if the insured has maintained continuous coverage, retaining the employer health insurance tax exclusion (albeit with a cap), and so forth. My sense of it is that it’s not meant as a permanent Republican replacement for O-Care but rather as a proposal that might attract centrist Democrats in the short-term. Get Democrats to accept a more liberalized version of ObamaCare now and then try to build on that to open them up to more ambitious reforms later.

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My sense of it is that it’s not meant as a permanent Republican replacement for O-Care but rather as a proposal that might attract centrist Democrats in the short-term. Get Democrats to accept a more liberalized version of ObamaCare now and then try to build on that to open them up to more ambitious reforms later.

While getting completely rid of Ocare is the ultimate goal, waiting 3 years and hoping we gain both houses of Congress and presidency isn’t an option either. Do what we can to help, proving free market solutions would work.

You know why I feel that way, Tom? Because the story says you’ll just pay for it out of your own pocket. Thats great.

So now tell us

1) why we should give a damn that you lost your coverage (not really, you just have pay for it yourself)

2) what would you say to someone in your position who didn’t spend a considerable amount of time in Congress and managed to enrich himself while he was there, and will now most likely die of cancer that was otherwise treatable…. at least until there was a universal healthcare initiative?

Not sure I understand your complaint here – single payer will have zero access to any of the hospitals or docs you would want to see. So the same problem will remain. Under the old system, many people could see these facilities. Right now these facilities are busy laying off support staff and lower level provider personnel in order to deal with their own cash flow issues they are experiencing with the advent of OCare.

When I was examining the networks for Blue Shield of California’s Obamacare plans I saw no difference between the platinum and bronze plans. Same networks.

Mark1971 on January 28, 2014 at 2:50 PM

The only difference between the various plans offered by a single insurer in ObamaCare are increased premiums vs. reduced deductibles and co-pays. The only choice in this crap sandwich is to pay at the front end, or to pay at the back end.

This is really going to create a two-tied healthcare system where the rich people and the government officials get the best doctors at the best hospitals, and the rest of us get marginal doctors at the lesser tier hospitals. FAIRNESS!

You know why I feel that way, Tom? Because the story says you’ll just pay for it out of your own pocket. Thats great.

So now tell us

1) why we should give a damn that you lost your coverage (not really, you just have pay for it yourself)

2) what would you say to someone in your position who didn’t spend a considerable amount of time in Congress and managed to enrich himself while he was there, and will now most likely die of cancer that was otherwise treatable…. at least until there was a universal healthcare initiative?

BobMbx on January 28, 2014 at 2:49 PM

And this, my friends, is what is wrong with liberals, example #121234254353469654878.

Senator Coburn doesn’t want sympathy. Senator Coburn is highlighting his personal example becase he’s concerned about “someone in (his) position who didn’t spend a considerable amount of time in Congress and managed to enrich himself while before he was there, and will now most likely die of cancer that was otherwise treatable”.

Your hero just sentenced that person to death. And all you can bleat is “but, but, but, UNIVERSAL HEALTHCARE will solve it!”

The best thing the republicans ever did was stick an amendment to force the congress critters to join OboobieCare. Embrace the suck on one hand and on the other, may more of them be blessed with interesting OboobieCare coverage over the next few months.

This is no surprise to many of us with a chronic disease. My neurologist, who has been treating my multiple sclerosis for years decided he can’t maintain a practice with all the new rules, regulations and fees under ObamaCare and quit his practice. He and his family moved back to Hydrabad where he can run his practice the way he wants and the way it’ll benefit his patients without a lot of federal government interface.

Think signing up for health insurance through Covered California is hard? Some consumers say the real battle starts when it comes to finding a doctor or hospital that will take a plan purchased through the state-run health exchange.

…

But now that coverage has started, some people are finding it tough to determine whether their doctor or hospital will accept their coverage. Consumers say the insurer’s directory of doctors and hospitals is inaccurate or out of date. In some cases, the doctors don’t even know what to tell their patients. “There’s a lot of confusion. The physicians don’t know if they’re actually participating” in the exchange’s networks, said Donald Waters, executive director of the Alameda-Contra Costa Medical Association, which represents 3,100 doctors in the East Bay.

The problem is not limited to California. A study released last month by the consulting group McKinsey found that many plans sold through the federal health law are using “narrow” or “ultra narrow” networks – physician and hospital lists that are limited to lower costs.

In more than two-thirds of all exchange networks analyzed by McKinsey, at least 30 percent of the largest 20 local hospitals were excluded. Insurers say the move to limit the number of doctors and hospitals on a network was necessary to keep the costs of premiums low.

In California, plans offered by Blue Shield through Covered California included just 60 percent of the doctors that participate in the insurer’s group plans and just 75 percent of the hospitals. On top of that, Blue Shield is reimbursing doctors and hospitals in Covered California policies up to 30 percent less than those not in the exchange, spokesman Stephen Shivinsky said.

…

Kearney had even opted for more comprehensive coverage including a PPO, or preferred provider organization plan. “I chose a PPO so I could have had choice,” she said. “The thing is, now I have nothing to choose from.”

Prior, those who could not afford to pay out of pocket did not have access to life-saving care.

verbaluce on January 28, 2014 at 3:39 PM

How can a person be so Fluking ignorant? Nobody was denied life saving care before ObamaCare. Health insurance does not equal healthcare, and there were state and federal laws prior to ObamaCare that dictated persons could not be denied care.

Now, how do you jibe this colossal bit of ignorance on your part with the notion that our healthcare system was bankrupting everyone? How is it possible to bankrupt anyone if they’re being denied care because they aren’t likely to pay for it?

Logic doesn’t matter? Just throw everything at the wall in your ignorant quest to wreck everything?

Previously, those who could not afford to pay out of pocket (Most people) had private or employer-provided health insurance. (total uninsured adults was around 7% of the populace, most of them by choice.) Now the private market is DEAD, killed by Obamacare.

However, that was just the small potatoes. Wait until Obamacare kills the employer provided market! We will literally have a rolling body count as the number of people dying from otherwise treatable diseases starts racking up.

And it will be your fault and the fault of all who voted this moron into office. I wouldn’t want your karma. I suspect your next several lifetimes will be spent as fecal coli-form bacteria.

Hmm. Then again, it won’t be much of a change from your current state. Maybe you won’t notice.

I’m worried about my kids. I have 2 kids with medical needs. My eldest takes several medications to help modify her more extreme behavior problems stemming from her ASD. (She is a mostly non-verbal Autistic child with self-destructive and aggressive tendencies since birth. Her meds keep her stable and able to function as much as she can.)

My youngest has Spina Bifida. She takes a regular regimen of antibiotics to ward off infections from being catheterized multiple times per day (so she can pee). That’s over and above the medications she takes to keep her bladder muscles relaxed so her urine doesn’t back up into her kidneys and kill her. Oh, and there is the cost of her physical therapist and the braces for her ankles so she can walk AT ALL.

So we are pretty dependent on our employer provided insurance to cover all of these costs as we could never afford them out of pocket. Our daughter’s Neurologist, orthopedic surgeon and several other doctors and specialists are NOT in the network of any Obamacare compliant private plan. I don’t expect the Obamacare compliant employer provided plans to be any better. Which means if Obamacare isn’t gotten rid of and SOON, my daughter’s LIFE is at stake.

I cannot describe what the soul-crushing fear of having the government essentially come in and threaten the life of your child is like. We MUST get rid of Obamacare, and FAST!

Ah, so this is how the Dems expect to escape the wrath of voters… just kill off all their competition with exemptions placed on key groups such as Unions which normally vote Dem. You keep their congressmen and voters alive you eventually gain a majority.

But Mr Priselac at Cedars-Sinai in Los Angeles says the creation of ever more narrow provider networks by insurers is being driven by price alone, and not by quality. He says the hospitals that are being excluded are leaders in innovation, which saves billions of dollars for the healthcare system in the long run.

Seriously, what did you expect them to be driven by? Health insurance companies have far higher expenses, and they’ve already had to jack up the premiums and the deductibles in order to make ends meet. Reducing quality is about the only thing they have left to keep from going broke.

The irony, of course, is that some of them saw the promise of a mandate and thought this would be a good thing for their business.

Prior, those who could not afford to pay out of pocket did not have access to life-saving care.

verbaluce on January 28, 2014 at 3:39 PM

How can a person be so Fluking ignorant? Nobody was denied life saving care before ObamaCare. Health insurance does not equal healthcare, and there were state and federal laws prior to ObamaCare that dictated persons could not be denied care…

NotCoach on January 28, 2014 at 3:50 PM

From almost exactly one year ago:

That’s cute that you think a surgical office capable of repairing a complicated fracture is too inept to set up a 48 month payment plan.

Your hero just sentenced that person to death. And all you can bleat is “but, but, but, UNIVERSAL HEALTHCARE will solve it!”

makattak on January 28, 2014 at 3:17 PM

Oh my.

I’m no liberal. At all. My complaint about Tom is that he was a member of Congress when this legislative abortion was passed. He didn’t vote for it. He didn’t stop it, either. His side lost. That makes him a loser. He was sent to Congress to represent conservative values and failed. This assessment applies to each and every “conservative” in Congress the day the vote was held.

Tom failed me. I couldn’t care less about his troubles. I’ve got my own to deal with.

The Obamacare Plan: make it as unaffordable as possible, take away all the good hospitals, make the pool of Drs and hospitals real small, and let those with pre-existing conditions, flail about needing a Dr, cuz they can’t keep the ones they have and hopefully they will die off waiting to get Health Care…wash rinse and repeat ad infinitum…